The use of a surgical incision management system on vascular surgery incisions: a pilot study

Abstract

Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

“…All three wound infections (6%) in the Matatov study were classified as Szilagyi grade I, while in this study, there were four incision complications classified as Szilagyi grade I and only one grade II. Similarly, the results of this study were consistent with the results of Weir (with only two incision complications) and Karl and Woeste (with no complications) after application of ciNPT. This observation supports the reduction of incision complications in deep tissue layers with possible revision surgeries when ciNPT is utilised.…”

“…In spite of many publications, clinical studies involving groin wounds are rare. To date, there exist only four clinical studies in which ciNPT were examined on groin wounds after vascular surgeries (4,9,10,40).…”

“…A polyurethane shell encapsulates the foam bolster and interface layer, providing a closed system. Until now, four clinical studies have reported on the use of the ciNPT in the groin after vascular surgeries (4,9,10,40); however, these studies lacked a prospective, randomised study design and a subgroup analysis of risk factors and perioperative parameters. The aim of this study was to investigate the effectiveness of ciNPT compared to conventional therapy with regards to the incidence of groin WHC on postoperative days 5-7 and 30 and the incidence of surgery revisions 30 days postoperatively after various vascular surgeries.…”

“…Additional wound-healing complications (WHC) in the groin include wound dehiscence, lymphatic leaks with lymphatic fistula and lymphocele, seroma, haematoma, skin necrosis and delayed healing (1)(2)(3)(4)(5)(6)(7). Surgical site infections (SSIs) are present in 2-22% of all surgical procedures and contribute more than 20% of the costs of all complicated wounds (8,9). In accordance with international data, the incidence of SSIs after vascular surgery in the groin are 3-44%, and deep groin…”

Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

“…27 These studies found that the use of incisional negative pressure therapy immediately after surgery decreased the number of SSIs, 12,13,16,17,19 overall wound complications, 13,15,17,27 seroma formation, 24,25 and complications requiring repeat surgery. 14,15,20 Also noted were reduced length of stay in hospital 18,27 and in intensive care unit, 20 reduced wound drainage, 21,[24][25][26] and time needed for dressing changes. 25,27 Finally, shortened time for drain removal 26 and increased ability to self-care 18 have also been identified.…”